Catastrophic Care

Starred review from November 5, 2012
Nearly three years ago, Goldhill's father died from a series of infections contracted during his stay in an ICU unit of a well-known hospital, a tragedy first recounted by the author in a cover story for the Atlantic in 2009. Goldhill returns to his story and greatly expands on it in this fascinating and infuriating exposé of the American health care system, identifying its many flaws and suggesting pragmatic ways to fix them. Maintaining that the health care industry needs to answer first to consumers and then to insurance and pharmaceutical companies, Goldhill persuasively argues that a consumer-driven systemâwhich will require greater vigilance and commitment on the part of citizens in actively managing their healthâis the first step toward sustainability and lower individual and governmental costs. Deftly avoiding political land mines, Goldhill takes a fittingly clinical approach, examining the intricacies of Medicare ("already doomed, a victim of the perverse incentives inherent in its structure") and the Affordable Care Act before presenting his vision of recipient-based care. Goldhill's reasoned, logical alternative to the current system goes beyond political finger-pointing, and while his take is sobering, it's one that offers sound solutions. First printing: 50,000. Agent: The Zoe Pagnamenta Agency.

November 15, 2012
A media executive's take on our health care system's flaws and plan for a totally different approach. When Goldhill witnessed the death of his father from a hospital-borne infection, he decided to analyze the industry to understand how such a tragedy could occur, concluding that it does not live up to the standards of other industries in our economy. Contrary to the views of acclaimed economists Ken Arrow and Paul Krugman, Goldhill, who has not worked in the health care industry, asserts that the reason the industry provides poor customer service at unaffordable prices and gets uneven results is in large part because market forces are not at work. Patients have ceded their role as consumers to big intermediaries, including insurance companies, Medicare and Medicaid. As in other businesses, he argues, demanding consumers (i.e., patients) can affect quality of services, prices and safety. Goldhill proposes a system that combines a national insurance plan with a market-based system. His plan has three components: mandatory cradle-to-grave catastrophic health insurance with low premiums and a very high deductible; health savings accounts to which individuals would be required to contribute payments based on their age; and health loans, which would enable individuals to borrow against future contributions to their health savings accounts in the event of a costly but not catastrophic illness or accident. The author acknowledges that transitioning into a system that makes each individual a purchaser of his or her own health care might take a couple of generations, but he provides some guidelines for easing into it gradually. Highly readable presentation of one businessman's solution, likely to provoke discussion if not agreement.

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December 1, 2012
Dysfunctional and undisciplined. That is Goldhill's assessment of the current U.S. health-care system. President and CEO of the Game Show Network, Goldhill believes the trouble stems from a culture lacking customer accountability: high prices, excess, errors, underinvestment in information technology, lack of follow-up. Spurred by the death of his father from a hospital-acquired infection, Goldhill has devoted considerable time and thought to repairing health care. His book sprouted from a 2009 article he penned for the Atlantic. Encounters with the health-care system usually involve gargantuan intermediariesMedicare, Medicaid, and private insurance companies, entities Goldhill cites for inefficiency. They also generate increased demand for services. His alternative to the status quo combines national health insurance (for everyone but not everything) with a market-based system that gets rid of intermediaries and allows individuals to deal directly with providers. Individual health accounts, catastrophic insurance with a high deductible, and health loans are key components. The health-care system is gashed. Goldhill thinks it's time to rip off the colossal Band-Aid and apply a different kind of balm.(Reprinted with permission of Booklist, copyright 2012, American Library Association.)